Diaphragmatic Hernia Following Liver Transplantation in Pediatric Patients: Case Series and a Review of the Literature
Related Experiment Video
Updated: May 13, 2026
Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
Mutaz Sultan1,2, Thomas Ciecierega3, Ahmed Aliwisat4
1Faculty of Medicine, Al-Quds University, East Jerusalem, Palestine.
Insights
Acquired diaphragmatic hernia (DH) after pediatric liver transplantation (LT) is rare, occurring in about 10% of cases. Early recognition and surgical repair are crucial for favorable outcomes in these complex pediatric liver transplant patients.
Area of Science:
- Pediatric Surgery
- Hepatobiliary Surgery
- Transplantation Medicine
Background:
- Acquired diaphragmatic hernia (DH) is a rare complication following pediatric liver transplantation (LT).
- Early identification and management are critical for patient outcomes.
Purpose of the Study:
- To describe six pediatric cases of acquired DH post-LT.
- To characterize clinical presentation, management, and outcomes.
- To review existing literature on DH following pediatric LT.
Main Methods:
- Retrospective case series of pediatric patients who developed DH post-LT.
- Data collection included demographics, transplant details, clinical presentation, surgical management, and outcomes.
- A comprehensive literature review was performed.
Main Results:
- Six cases identified, suggesting an incidence of approximately 10% in pediatric LT recipients.
- Median age at LT was 43 months, with DH occurring a median of 5.5 months post-transplant.
- Respiratory distress and abdominal pain were common; prompt surgical repair was effective, with one case requiring bowel resection due to ischemia and one recurrence.
Conclusions:
- Acquired diaphragmatic hernia (DH) is a recognized, albeit rare, complication after pediatric liver transplantation (LT).
- Increased awareness and prompt diagnosis are essential for timely surgical intervention and improved patient outcomes.
Objectives:
Acquired diaphragmatic hernia (DH) is a rare yet serious complication following liver transplantation (LT) in pediatric patients. We aimed to describe six pediatric cases who developed DH following LT, characterize their clinical presentation and management, and provide an updated review of the existing literature.
Methods:
This retrospective case series of pediatric patients who developed DH following LT and were followed up at Makassed Hospital, a tertiary referral center in East Jerusalem, between January 2015 and March 2025. Demographic characteristics, transplant details, clinical presentation, surgical management, and outcomes were extracted from medical records. In addition, a comprehensive literature review was conducted to identify previously reported cases of DH following pediatric LT.
Results:
Six cases were identified. Based on the Ministry of Health referral records, indicating approximately 58 pediatric LTs from our region during the same period, this corresponds to an estimated incidence of about 10%. Median age at LT was 43 months, with DH developing after a median interval of 5.5 months. All patients received a left lateral segment graft, except for one who had a left lobe graft. Respiratory distress and abdominal pain were the predominant symptoms. Prompt primary surgical repair was performed in all patients. There was one case complicated by bowel ischemia, which required bowel resection. Recurrence was detected in one patient.
Conclusions:
DH following LT is rare but well recognized. Increased awareness and early recognition are essential to ensure timely surgical management and favorable outcomes.
